Basic Information
| Provider Information | |||||||||
| NPI: | 1578068235 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TITLE | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | FNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6200 PINE HOLLOW DR STE 400 | ||||||||
| Address2: | |||||||||
| City: | EAST LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488239224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5173391676 | ||||||||
| FaxNumber: | 5173392716 | ||||||||
| Practice Location | |||||||||
| Address1: | 6200 PINE HOLLOW DR STE 400 | ||||||||
| Address2: | |||||||||
| City: | EAST LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488239224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5173391676 | ||||||||
| FaxNumber: | 5173392716 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2018 | ||||||||
| LastUpdateDate: | 03/26/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 4704238068 | MI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.